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Thread: Ischial Tuberosity Pain

  1. #1

    Thumbs down Ischial Tuberosity Pain

    My partner is a T5 ASIA B paraplegic, who became that way about a year and a half ago, as a result of leaving his blood vessels clamped down for too long during aorta surgery. For about a year, he has had pain on his butt, around the location of the left Ischial Tuberosity. The right Isch has no pain. Changing wheelchair cushions has helped some, but not consistently. He has had multiple pressure mappings and trips to the chair clinic. Getting off his chair and lyng on the bed horizontally helped some, but not consistently. Absolutely nothing is visible on the skin. His doctors at Spaulding Rehab and Lahey Clinic have nothing to suggest. Does anyone have ideas on what the cause might be or how to treat it?
    Last edited by mgwmgw; 08-23-2011 at 09:38 AM.

  2. #2
    One might ask why was his aorta being clamped and this could have also caused the lack of flow to spinal cord such as TAA????.... Sounds neuropathic but what do is arteries look like in this area? Is the blood getting to that area? being perfused? Had an arteriogram post op or before? On Aspirin or plavix or something?? Hope he doesn't smoke. If he does he should quit.
    Also could be neuropathic- or a little of both causes. Is he on Gabapentin? start with low dose and work slowly up.
    CWO

  3. #3

    Why Aorta Clamped

    He was hit by a piece of falling tree.
    It broke some ribs and his leg,
    and one of the ribs punctured the aorta.
    They had to fix the aorta before it ruptured,
    and because of the other injuries could not give him
    the usual blood thinning medicines.
    The surgery took longer than I was originally told to expect,
    and nobody told me why.

    The leg and ribs have now recovered,
    but the paraplegia remains.
    He can wiggle a toe or two and tense a leg muscle.
    No spasms.

    The pain could be neuropathic.
    The normal medicines against neuropathic pain
    such as lyrica
    have not been effective on this.
    If it is neuropathic, what would you suggest?
    Acupuncture?

  4. #4
    It's very likely a pressure sore waiting to happen. When pressure is relieved and circulation is back the pain sets in. If it were me I'd get a big thick 4-5 inch piece of foam rubber and carefully cut out an area right below the sacrum and ischium so he can sit with no pressure at all in that specific area.

  5. #5
    We do butt checks regularly, and there is nothing on the skin.
    This has been going on for about a year with no sore forming.
    This is what is so puzzling.

  6. #6
    That's because there's not yet enough tissue hypoxia for a sore to form; so far there's enough circulation so that there's no overt tissue damage. YET If it hurts it's telling you that something is wrong. If changing seating and lying in bed with pressure off the ischium helps that is telling you that pressure on the ischium is causing pain that is a presursor to tissue damage; take the body wejight off the ischium and the pain and risk of tissue injury is ameliorated.

    Sacral and ischial sores are incredibly common. Much easier to prevent than cure. Don't wait for overt tissue damage; use a cut-out seat, sacral pillow whatever until there is no pain. Ideally you want that area elevated so that it's not in direct contact i.e. absolutely no pressure. Try a deep cushion with the cut out over the ischium.

    I mean...if you grab a hot frying pan you let go ASAP and don't wait until you see blisters.

    I had similar pain, ignored it, ended up with a nasty sore. Now whenever I feel sacral or ischial pain I use a cushioned seat with a cut-out so there's no pressure. Hope this helps!

  7. #7
    I strongly disagree with avictoria. If this pain has been present for a year and there is no visible skin damage in the area, the cause is far more likely to be central (neuropathic) pain.

    What kind of pain is it? A cold metallic burning? Pins and needles? A bruised feeling? Like there are invisible faeries attacking the isch and the skin with Brillo pads?

    If it is central pain, gabapentin, topamax, lyrica, etc. are the meds most likely to offer relief. They are often taken in combination with one another, but may not work for everyone. Many of us supplement those drugs with opiates, which doesn't really relieve the pain as much as it does numbs you.

    Check out the pain forum here for more in-depth info.
    It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with patience.

    ~Julius Caesar


  8. #8
    http://emedicine.medscape.com/article/190115-overview
    Decubitis ulcers

    In the section named “etiology” (causes)
    Sensory loss also contributes to ulceration, by removing one of the most important warning signals, pain.”

  9. #9
    Ah! so they didn't let him bleed to death- worth clamping the aorta. Did they mention anything about vessels off the aorta?
    I would say it is lack of blood supply and neuropathic pain and could have some pressure area underneath but definitely nerve involved.triggers it.
    Lyrica- max dose? Cymbalta can be given with Gabapentin but notwith Lyrica. Topamax is newer and is being tried.
    Have you tried Lidocaine patches to that area?
    Pain specialist?
    CWO

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